Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy

To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence healthcare professional decisions on RA administration. Methods: A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 hours before (Time 1; T1) and 48 hours after (Time 2; T2) surgery. At Time 1, baseline demographic, clinical and psychological predictors were assessed and at Time 2, post-surgical pain, anxiety and RA administration were recorded. Results: After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states (OR, 4.551; 95% CI, 1.642-12.611, p = 0.004), being anesthetized with only general or locoregional anesthesia (OR, 5.349; 95% CI, 1.976-14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031-1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353-1.871, p < 0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084-1.430, p = 0.002) were significantly associated with RA provision. Conclusions: Healthcare decision-making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision-making on RA provision. Implications for practice are discussed.This work was supported by a grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology